This continuing education course provides comprehensive knowledge concerning the relationship between the connective tissue surrounding the visceral structures of the gastrointestinal system as it relates to normal function of the musculoskeletal system. Students will learn a variety of manual therapy techniques for mobilizing the fascial structures of the gastrointestinal viscera as they relate to the somatic frame.

• The fascial system consists of four concentric layers, with the visceral layer, which is the most complex, beginning at the naso-pharynx and ending at the anal aperture (1) .
• The abdominopelvic canister is “A functional and anatomical construct based on the components of the abdominal and pelvic cavities that work together synergistically” (2).
• The walls of the canister, although part of the musculoskeletal system, are intimately connected to the visceral structures found within via fascial and ligamentous connections (3).
• In order to function optimally the viscera must be able to move, not only in relationship to one another, but with respect to their surrounding container (4).
• Most importantly, the viscera are subject to the same laws of physics as the remainder of the locomotor system with solid structures such as the liver and spleen particularly affected by blunt force trauma (5, 6).

Information is presented on embryology of the viscera and connective tissue system as it applies to associated visceral and fascial anatomy. The science behind and evidence supporting visceral and fascial-based manual therapy for patients with a variety of diagnoses related to musculoskeletal and pelvic health physical therapy is incorporated into each lecture.

This manual therapy course emphasizes clinical reasoning with the goal of immediate implementation of an extensive number of treatment techniques into an existing musculoskeletal and pelvic health practice. The material presented has applications for diagnosis such as abdomino-pelvic pain, gastroparesis, GERD, constipation, abdominal adhesions, and urinary issues. Additionally, the solid organs of the GI system play a profound effect on the thorax contributing to spinal issues and breathing pattern dysfunction (Bordoni & Zanier ,2013). Course work is geared toward the pelvic health therapist who wishes to integrate advanced manual therapy skills into their treatment regime for their pelvic and orthopedic clientele.

This course includes extensive lab work, all attendees should come prepared to participate as both clinician and patient. Male course attendees may participate fully in the entire course. Pregnant attendees may participate in a limited capacity, as deep palpation to the abdomen is illadvised for pregnant women. Seminar content is targeted to licensed health care professionals working within the field of pelvic health. Content is not intended for use outside the scope of the learner's license or regulation.

Special Considerations:

As this continuing education course includes extensive lab work, all course attendees should come prepared to participate as both clinician and patient. Rectal pelvic floor muscle examinations will be taught in labs. Past participants have found that wearing comfortable clothing that is easy for changing (such as skirts or athletic shorts) is very useful for labs. Due to temperature variations from clinic to clinic we would recommend wearing comfortable layers.

PLEASE NOTE: This course includes internal assessment and exam techniques, which will be practiced in partnered pairs in lab time. H&W strives to foster an environment that is safe and supportive. Survivors of past trauma should be aware that performing or experiencing internal exam may be triggering, and that many, regardless of their histories, feel strong emotions when practicing these techniques. In order to foster an environment that is non-triggering and safe for all participants, we recommend all participants consider the emotional impact they may experience during the course, and consider consulting a trauma counselor or therapist prior to attending. Read more about What to Expect During Courses with Internal Lab Work.

References

1. Willard, F. H. (2012) Visceral fascia. In: Schleip R, Findley TW, Chaitow L, Huijing P (Eds.) Fascia-The Tensional Network of The Human Body. (pp. 53-56). Elsevier, Edinburgh.

2. Lee, D., Lee, L., McLaughlin, L. (2008). Stability, continence and breathing: The role of fascia following pregnancy and delivery. Journal of Bodywork and Movement Therapies, 12(4), 333-348.

3. Bordoni, B. & Zanier, E. (2013). Anatomic connections of the diaphragm: influence of respiration on the body system. Journal of Multidisciplinary Healthcare, 6, 281–291.

4. Uberoi, R., D'Costa, H., Brown, C., & Dubbins, P. (1995). Visceral slide for intraperitoneal adhesions? A prospective study in 48 patients with surgical correlation. Journal of clinical ultrasound, 23(6), 363-366.

5. Cheynel, N., Serre, T., Arnoux, P-J, Ortega-Deballon P., Benoit L. ,Brunet, C. (2009). Comparison of the biomechanical behavior of the liver during frontal and lateral deceleration.

6. Cox, E. (1984). Blunt abdominal trauma. A 5-year analysis of 870 patients requiring celiotomy. Annals of Surgery. 199(4), 467-474The Journal of Trauma, 67(1), 40-44